Fundamentals 2023 Proctor
A charge nurse is reinforcing teaching with a newly licensed nurse who is setting up a
sterile field. Which of the following actions by the newly licensed nurse indicates an
understanding of the teaching?
opening the first flap of a sterile package toward herself
dropping sterile gauze onto the field from a height of 7.5 cm (3 in)
removing and inverting a lid before placing it onto a nonsterile surface
maintaining the sterile field below waist level. - ANS -removing and inverting a lid
before placing it onto a nonsterile surface
A nurse and an assistive personnel (AP) are providing postmortem care for a decease
client prior to visitation by the family. Which of the following actions by the AP requires
intervention by the nurse?
Fathering the client's personal belongings.
Removing the client's dentures.
Placing absorbent pads under the client's buttocks.
Closing the client's eyes. - ANS -Removing the client's dentures.
A nurse assisting with the admission of a client to a medical-surgical unit. Which of the
following findings should the nurse identify as an indication that the client is
malnourished?
Heart rate 89/min.
Pink mucous membranes.
Pallor with scaly skin.
Body mass index 23 - ANS -Pallor with scaly skin.
A nurse in reinforcing teaching about carbohydrate counting with a client who has a new
diagnosis of diabetes mellitus. Which of the following actions should the nurse take
first?
Use pictures of different food groups to help the client plan a daily menu.
Ask the client what they already know about meal planning.
,Give the client a brochure with sample menus for all meals.
Involve the family in the discussion of the client's meal plan. - ANS -Ask the client what
they already know about meal planning.
A nurse is assisting with the admission of an adult client to a medical-surgical unit.
Which of the following findings should the nurse identify as an indication that the client
is malnourished?
heart rate 89/min
pink mucous membranes
pale, scaly skin
body mass index 23 - ANS -pale, scaly skin
A nurse is assisting with the care of a client who has a prescription for IV therapy. The
client tells the nurse that he has numerous allergies. Which of the following allergies
should the nurse bring to the attention of the charge nurse prior to the initiation of the
therapy?
eggs
latex
seafood
bee stings - ANS -latex
A nurse is caring for a client who has a new diagnosis of cancer. Which of the following
actions by the nurse maintains the client's confidentiality?
Sharing the client's prognosis with a member of the client's family.
Discussing the client's status with a member of the spiritual support team.
Collaborating with a nurse from another unit about the client's care.
Providing client information to another nurse at change of shift. - ANS -Providing client
information to another nurse at change of shift.
A nurse is caring for a client who has a new prescription for oxygen at 7 L/min via
simple face mask. Which of the following actions should the nurse take to ensure client
safety?
keep the side holes of the mask closed
ensure the reservoir bag is inflated on expiration
apply petroleum jelly to the clients nostils
, attach a humidifier to the base of the flow meter - ANS -attach a humidifier to the base
of the flow meter
A nurse is caring for a client who has a new prescription for oxygen at 7 L/min via
simple face mask. Which of the following actions should the nurse take to ensure client
safety?
Keep the side holes of the mask closed.
Ensure the reservoir bag is inflated on expiration.
Apply petroleum jelly to the client's nostrils.
Attach a humidifier to the base of the flow meter. - ANS -Attach a humidifier to the base
of the flow meter.
A nurse is caring for a client who has a prescription for a high-protein diet to
promote wound healing following surgery. The client's religion prohibits eating
meat on particular days. Which of the following actions should the nurse take?
a. encourage the client to eat meat during this time to promote healing
b. advise the client to eat everything on the tray except the meat
c. suggest the client receive high-protein enteral feedings
d. ask the dietitian to recommend alternative food choices for the client - ANS -ask the
dietitian to recommend alternative food choices for the client
A nurse is caring for a client who has an indwelling urinary catheter. Which of the
following actions should the nurse take?
clean the perineal area at least once a day
empty the drainage bag when it is three-fourths full
flush the catheter with sterile water daily
disconnect the drainage bag when emptying and measuring urine - ANS -clean the
perineal area at least once a day
A nurse is caring for a client who has an indwelling urinary catheter. Which of the
following actions should the nurse take?
Clean the perineal area at least once a day.
Empty the drainage bag when it is three-fourths full.
Flush the catheter with sterile water daily.
Disconnect the drainage bag when emptying and measuring urine. - ANS -Clean the
perineal area at least once a day.
A charge nurse is reinforcing teaching with a newly licensed nurse who is setting up a
sterile field. Which of the following actions by the newly licensed nurse indicates an
understanding of the teaching?
opening the first flap of a sterile package toward herself
dropping sterile gauze onto the field from a height of 7.5 cm (3 in)
removing and inverting a lid before placing it onto a nonsterile surface
maintaining the sterile field below waist level. - ANS -removing and inverting a lid
before placing it onto a nonsterile surface
A nurse and an assistive personnel (AP) are providing postmortem care for a decease
client prior to visitation by the family. Which of the following actions by the AP requires
intervention by the nurse?
Fathering the client's personal belongings.
Removing the client's dentures.
Placing absorbent pads under the client's buttocks.
Closing the client's eyes. - ANS -Removing the client's dentures.
A nurse assisting with the admission of a client to a medical-surgical unit. Which of the
following findings should the nurse identify as an indication that the client is
malnourished?
Heart rate 89/min.
Pink mucous membranes.
Pallor with scaly skin.
Body mass index 23 - ANS -Pallor with scaly skin.
A nurse in reinforcing teaching about carbohydrate counting with a client who has a new
diagnosis of diabetes mellitus. Which of the following actions should the nurse take
first?
Use pictures of different food groups to help the client plan a daily menu.
Ask the client what they already know about meal planning.
,Give the client a brochure with sample menus for all meals.
Involve the family in the discussion of the client's meal plan. - ANS -Ask the client what
they already know about meal planning.
A nurse is assisting with the admission of an adult client to a medical-surgical unit.
Which of the following findings should the nurse identify as an indication that the client
is malnourished?
heart rate 89/min
pink mucous membranes
pale, scaly skin
body mass index 23 - ANS -pale, scaly skin
A nurse is assisting with the care of a client who has a prescription for IV therapy. The
client tells the nurse that he has numerous allergies. Which of the following allergies
should the nurse bring to the attention of the charge nurse prior to the initiation of the
therapy?
eggs
latex
seafood
bee stings - ANS -latex
A nurse is caring for a client who has a new diagnosis of cancer. Which of the following
actions by the nurse maintains the client's confidentiality?
Sharing the client's prognosis with a member of the client's family.
Discussing the client's status with a member of the spiritual support team.
Collaborating with a nurse from another unit about the client's care.
Providing client information to another nurse at change of shift. - ANS -Providing client
information to another nurse at change of shift.
A nurse is caring for a client who has a new prescription for oxygen at 7 L/min via
simple face mask. Which of the following actions should the nurse take to ensure client
safety?
keep the side holes of the mask closed
ensure the reservoir bag is inflated on expiration
apply petroleum jelly to the clients nostils
, attach a humidifier to the base of the flow meter - ANS -attach a humidifier to the base
of the flow meter
A nurse is caring for a client who has a new prescription for oxygen at 7 L/min via
simple face mask. Which of the following actions should the nurse take to ensure client
safety?
Keep the side holes of the mask closed.
Ensure the reservoir bag is inflated on expiration.
Apply petroleum jelly to the client's nostrils.
Attach a humidifier to the base of the flow meter. - ANS -Attach a humidifier to the base
of the flow meter.
A nurse is caring for a client who has a prescription for a high-protein diet to
promote wound healing following surgery. The client's religion prohibits eating
meat on particular days. Which of the following actions should the nurse take?
a. encourage the client to eat meat during this time to promote healing
b. advise the client to eat everything on the tray except the meat
c. suggest the client receive high-protein enteral feedings
d. ask the dietitian to recommend alternative food choices for the client - ANS -ask the
dietitian to recommend alternative food choices for the client
A nurse is caring for a client who has an indwelling urinary catheter. Which of the
following actions should the nurse take?
clean the perineal area at least once a day
empty the drainage bag when it is three-fourths full
flush the catheter with sterile water daily
disconnect the drainage bag when emptying and measuring urine - ANS -clean the
perineal area at least once a day
A nurse is caring for a client who has an indwelling urinary catheter. Which of the
following actions should the nurse take?
Clean the perineal area at least once a day.
Empty the drainage bag when it is three-fourths full.
Flush the catheter with sterile water daily.
Disconnect the drainage bag when emptying and measuring urine. - ANS -Clean the
perineal area at least once a day.
